Provider Demographics
NPI:1154095693
Name:ISAYEV, ABULFAZ
Entity Type:Individual
Prefix:DR
First Name:ABULFAZ
Middle Name:
Last Name:ISAYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 ACORN PARK DR APT 5415
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1437
Mailing Address - Country:US
Mailing Address - Phone:857-333-6948
Mailing Address - Fax:
Practice Address - Street 1:155 MARKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1922
Practice Address - Country:US
Practice Address - Phone:978-591-6408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist